In his December speech to commemorate the 23rd annual World AIDS Day, President Obama said what should be obvious to all Americans yet is not: “When new infections among young black gay men increase by nearly 50% in three years, we need to do more to show them that their lives matter.”

Obama was referring to the rise in HIV infections for gay and bisexual African-American men between 2006 and 2009 — a period when infection rates among other populations remained steady, according to figures from the Centers for Disease Control and Prevention. Recent data on African-American women, meanwhile, shows rates of infection alarmingly higher than health officials once thought.

Together, the numbers illuminate a sobering reality: Despite myriad prevention efforts, the domestic HIV/AIDS agenda has done too little, too late, both in reducing infection and ensuring access to care for communities most at risk. “When this administration came into office, our domestic HIV/AIDS strategy was basically to keep doing what we were doing,” U.S. Secretary of Health and Human Services Kathleen Sebelius said in a February keynote at the White House Conference on LGBT Health. “We weren’t adapting fast enough. Agencies and programs weren’t working together well enough.” Sounding hopeful tones in her speech that echoed the president’s, Sebelius said the new National HIV/AIDS Strategy “has breathed new life into the fight against HIV and AIDS by focusing our resources on the populations that are most affected.”

Yet as the administration seeks to achieve the ambitious goals laid out in the national strategy, it is met with yet another troubling reality: complacency. Far fewer Americans consider HIV to be an urgent concern today than did in the 1990s. Even the gay community’s growing (and sometimes singular) focus on marriage equality, however laudable the goal, has shifted attention away from some of the most vulnerable LGBT Americans. If black Americans don’t believe the larger gay and lesbian movement cares about their lives, why should they invest in it?

HIV/AIDS isn’t the only health crisis facing black Americans, who also have higher rates of diseases such as diabetes and sickle-cell anemia. But understanding the real reasons for why new infections have risen dramatically has proved duly challenging. Far too often, experts and advocates say, the media have been obsessed with the “down-low” phenomenon and the false assumptions that come with it rather than concerned with how factors such as poverty and access to health care fuel the epidemic.

The Advocate recently spoke with leading experts on HIV/AIDS about how it affects African-Americans, and what both the administration and the LGBT community need to consider in order to successfully fight the disease and the stigma it sows. Here are five takeaways:

1. If you assume that the “down-low” phenomenon is the root cause of the HIV/AIDS epidemic among black gay and bisexual men, you’re missing the bigger picture.

This year the White House has hosted multiple conferences nationwide on LGBT issues (not coincidentally, a campaign-year initiative) on topics including bullying in schools, poverty, and homelessness. These issues are all related to each other and to the HIV epidemic. Yet they are often passed over in media coverage for a pervasive focus on down-low culture in trying to understand the reasons why black gay men are contracting HIV at six to eight times the rate of their white counterparts. “Almost every time I hear talk about the down low, I remember the feeling of being blamed for something I did not do,” Keith Boykin wrote in the 2005 book Beyond the Down Low: Sex, Lies, and Denial in Black America. “Facts are not important in this environment. Perception is reality.”

Aisha C. Moodie-Mills, adviser for LGBT policy and racial justice, Center for American Progress: What we know from the research is that black MSM [men who sleep with men] are not engaging in any more risky behavior than white MSM. And so that in and of itself is not why the rates are so high. We’ve got to look deeper at the intersections. What we often haven’t looked at are the larger structural conditions. How is the incarceration rate among all of these marginal populations contributing to the spread of this disease? How is poverty, lack of access to quality health care — not only of treatment, but also of the ability to know your status — contributing as well?

A. Cornelius Baker, member, Presidential Advisory Council on HIV/AIDS: We need to be absolutely clear that HIV happens to our community, because we need to be part of the solution to end it. We can’t hide it under a rock. But we also need to be clear that it’s not because of some hypersexuality in our communities. It’s not because we’re doing far more of all the bad things than any other population. When young gay men are thrown out of their homes, which is one of the leading ways that they become homeless, they’re put at much greater risk for HIV. When we look at bullying in the schools and the way it marginalizes a lot of transgender people and young gay men at school — that affects their economic progress for the rest of their lives. And that makes them much more vulnerable to HIV. There are factors that are contributing to young people, especially in the black community, not having the ability to be able to escape from a cycle of poverty and disease. And it’s not solely HIV. HIV is perhaps the worst manifestation, but it’s a whole lot of things that factor into HIV becoming that worst manifestation.